Skip all navigation Skip to page navigation

DHHS Home | A-Z Site Map | Divisions | About Us | Contacts

NC Department of Health and Human Services
NC Division of Public Health
N.C. Public Health Home

Hepatitis A


Outbreak of Hepatitis A in North Carolina

Multiple states have reported large outbreaks of hepatitis A associated with person-to-person transmission. Cases have occurred primarily among three risk groups: (1) persons who use injection or non-injection drugs; (2) persons who are experiencing homelessness; and (3) men who have sex with men. North Carolina is experiencing an outbreak of hepatitis A as described below, though not of the same magnitude as some other states.

Hepatitis A can be prevented by a safe and effective vaccine.  If you are in one of the risk groups described (a person experiencing homelessness, a person who uses injection or non-injection drugs, or a man who has sex with men) or if you had contact with someone with hepatitis A, contact your health care provider or local health department about hepatitis A vaccine.

Additionally, always wash your hands with soap and water after going to the bathroom, after changing diapers, and before preparing meals for yourself and others.

North Carolina Hepatitis A Outbreak-associated Cases, April 1, 2018 - May 14, 2020

Cases Hospitalizations Deaths
206 136 (66%) 1
County Cases
Alamance 2
Ashe 1
Bladen 1
Brunswick 1
Buncombe 11
Burke 1
Cabarrus 4
Caldwell 10
Carteret 1
Catawba 2
Cherokee 1
Cleveland 1
Columbus 1
Craven 1
Davidson 9
Durham 4
Forsyth 33
Gaston 1
Gates 1
Guilford 6
Harnett 4
Henderson 1
Iredell 3
Johnston 3
Lee 1
Macon 1
Madison 2
Mecklenburg 32
Onslow 1
Orange 2
Rockingham 2
Rowan 4
Rutherford 1
Stokes 15
Surry 15
Swain 1
Wake 16
Watauga 1
Wayne 6
Wilkes 2

Map of Hepatitis A Cases

Case Definition

Clinical Description

An acute illness with a discrete onset of any sign or symptom consistent with acute viral hepatitis (e.g., fever, headache, malaise, anorexia, nausea, vomiting, diarrhea, and abdominal pain), and either a) jaundice, or b) elevated serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels.

Case Classification


  • A case that meets the clinical criteria and is IgM anti-HAV positive*, OR
  • A case that has hepatitis A virus RNA detected by NAAT (such as PCR or genotyping) OR
  • A case that meets the clinical criteria and occurs in a person who had contact (e.g., household or sexual) with a laboratory-confirmed hepatitis a case 15-50 days prior to onset of symptoms

*And not otherwise ruled out by IgM anti-HAV or NAAT for hepatitis A virus testing performed in a public health laboratory

North Carolina Outbreak Case Definition

Outbreak-associated case:

An acute case of hepatitis A meeting the confirmed case classification with onset on or after January 1, 2018 in a North Carolina resident who:

  1. Reports at least one of the following risk factors: homelessness, drug use (injection or non-injection), or MSM status; OR
  2. Has a hepatitis A genotype that matches a genotype predominant in a recent or current US hepatitis A outbreak; OR
  3. Is epidemiologically linked to a person meeting one of the above criteria.


Information for the Community

Information for Health Care Providers

Best Practices